Conventional treatment for Bell’s palsy hinges on corticosteroids. Corticosteroids are used to reduce inflammation and help increase the likelihood of recovery of facial muscle function (Lampert 2012; Baugh 2013; Gilden 2004; Ronthal 2013b). A 10-day course of corticosteroids, such as 10 days of 50 mg of prednisolone or 60 mg prednisone for 5 days with a 5-day tapered dose, initiated within 72 hours of the onset of symptoms, is often used (Baugh 2013). Antiviral medications, such as acyclovir (Zovirax®) and valacyclovir (Valtrex®) can be added to the corticosteroid regimen, but studies have been inconclusive as to whether antivirals offer any significant benefit (Baugh 2013; Ronthal 2013b; Lampert 2012).
The impaired tearing that accompanies Bell’s palsy can put the eye at risk for damage. The cornea can become dry and scratched, which can lead to permanent vision problems. It is recommended that, while awake, patients should use artificial tears every hour, and at night they should apply ophthalmic ointments. Eye patches or protective glasses may also help (Ronthal 2013b).
Surgical decompression of the facial nerve may be indicated in some cases of Bell’s palsy. The facial nerve paralysis and subsequent damage caused by Bell’s palsy is thought to be due to swelling of the facial nerve. Surgical decompression of the facial nerve at its narrowest point may help improve outcomes for people with persistent, severely diminished (greater than 90% at two weeks) function (Gilden 2004; Koshal 2013; Tiemstra 2007). However, surgery for Bell’s palsy remains controversial. It is not clear how effective facial nerve decompression is at improving outcomes, as there are not enough well-designed clinical trials to fully determine its benefits (McAllister 2011; Tiemstra 2007; Baugh 2013).
Other surgical treatments are being developed to help people with long-term facial paralysis after Bell’s palsy. These include repair of the damaged facial nerve and nerve transfers/grafts. This latter option involves using a different nerve, such as the undamaged facial nerve on the other side of the face, as a source of healthy nerve fibers to connect parts of the damaged nerve (Hontanilla 2014). Another treatment involves transferring a muscle from elsewhere in the face to help restore movement to that area of the face (Koshal 2013). Although surgery may be beneficial for the treatment of Bell’s palsy in some cases, these surgical techniques may cause side effects such as hearing loss (Baugh 2013).